The White Review

Leukoderma may be congenital but, often, it is aggravated or even triggered due to negligence. here are some tips on how to deal with white patches — and precautions on how to steer clear of them

Read More

Botox® in Men

Botulinum Toxin type A injections, popularly known as Botox ® is the commonest cosmetic dermatology procedure performed worldwide. Botox relaxes facial muscles into which it is injected thereby reducing the facial lines resulting from muscle contraction. It is a relatively safe and easy procedure with very little downtime and the effect can last upto 6 months. Of late there has been a considerable increase in the number of men opting for this procedure accounting for almost one tenth of all Botox clients. This consistent increase in its popularity even during this period of global economic slowdown is seen by many as an attempt by the young executives to project a “fresh and pleasing” look in the highly competitive job market. However I have seen several senior people taking Botox® to keep up with the younger sub-ordinates. I am yet to see a male client taking Botox to be more attractive to the spouse, though that is the prime concern for most women.

Botox (Photo credit: AJC1)

Upper face Botox is more popular among men with frown lines being the commonest area treated. Reduction of frown lines will eliminate the 'angry/confused' look. Men generally don't mind having forehead lines. Hence I never try to knock out the forehead muscles completely while doing Botox for men. The same applies to crow's feet as well. Too much Botox near the eyes gives it a wider/bigger look which may not be too masculine. As a rule of thumb, men need more Botox for the same effect as in women as the muscles tend to be bigger. Botox is not a very painful procedure though women tend to endure the pain better.

Molecular targets of clostridial neurotoxins (CNTs) in presynaptic cell. BoNT/A-G:botulinum toxin A-G, TeNT:tetanus toxin. (Photo credit: Wikipedia)

Botox for hyperhidrosis (increased sweating on palms, soles and under arms) is popular among Men as in Women. However I feel the effect is more and longer lasting in men. New indications for Botox are being explored apart from the common neurological and cosmetic indications. One of my clients takes Botox regularly because it reduces his migraine along with his wrinkles! Studies have shown beneficial effects even in prostatic enlargement.

Men are not averse to cosmetic dermatology procedures any more and certainly not to Botox. But men generally look for a "cool dude" effect and not a mask like face.

Related articles

• Could Botox Cure Your Headaches? (everydayhealth.com)
• Dr. K: Be realistic about what Botox can fix (goerie.com)

Nailing it down

In my last article, I discussed the common conditions affecting nails. Now I will discuss certain uncommon causes of discoloured and disfigured nails. In most cases, the nail changes are not specific to any condition. Hence I should include a standard disclaimer that this is for informational purposes only and is not a substitute for professional medical advice.

Read More

Gene expression study in Acne

Image via Wikipedia

Anti-inflammatory effects of a topical preparation containing nicotinamide: "Anti-inflammatory effects of a topical preparation containing nicotinamide, retinol, and 7-dehydrocholesterol in patients with acne: a gene expression study"

'via Blog this'

This study published recently in dovepress journal, Clinical, Cosmetic and Investigational Dermatology highlights the importance of dysregulation of matrix metalloproteinase (MMP) and pro inflammatory cytokines like IL-6 in acne. The study shows that many MMPs and IL-6 are down-regulated when a topical preparation containing nicotinamide, retinol, and 7-dehydrocholesterol is applied. But does it mean that these MMPs are up-regulated in active acne? Except for MMP1, all other MMPs found to be down-regulated are gelatinases and not collagenases. Zinc is an important cofactor for MMPs while doxycycline is an inhibitor. Both are found to be useful in the treatment of acne. So the MMP expression changes demonstrated in this study could just be an incidental finding!

Related articles

• Increased immunoreactivity of membrane type-1 matrix metalloproteinase (MT1-MMP) and β-catenin in high-risk basal cell carcinoma (dx.doi.org)
• Management strategies for acne vulgaris (dovepress.com)
• Matrix Metalloproteinase-1 Inhibitory Activities of Morinda citrifolia Seed Extract and Its Constituents in UVA-Irradiated Human Dermal Fibroblasts. (medworm.com)
• An increased incidence of Propionibacterium acnes biofilms in acne vulgaris: a case‐control study (medworm.com)

A nail-biting story!

Image via Wikipedia

Recently a physician friend showed me a gray longitudinal streak on his fingernail and asked me if he was going to die soon. He had read in a health magazine that a longitudinal dark streak on your fingernail could be a sign of a lethal cancer called melanoma affecting the nail matrix. I showed him one of my fingernails with a similar streak and told him with a smile: “If you are going, I am coming with you!”

Read More

Related articles

• Linear Pitting and Splinter Haemorrhages Are More Commonly Seen in the Nails of Patients with Established Psoriasis in Comparison to Psoriatic Arthritis (medworm.com)
• Here's What Smoking Does to Your Nails (bellasugar.com)
• Stop biting your finger nails -spu - Newyork, United Kingdom (travelpod.com)

Can Anchoring Fibrils be reinforced by nanofibers?

Image via Wikipedia

Anchoring fibrils are polymers of Type VII collagen that connects basement membrane of the skin to the dermal connective tissue. Abnormalities of anchoring fibrils lead to a group of disparate and debilitating disorders called dystrophic epidermolysis bullosa (DEB). The mutation analyses and studies on genotype-phenotype correlations in epidermolysis bullosa have revealed an unusual complexity of the gene defects and their biological consequences. I even tried machine learning techniques to make sense of this complex genotype - phenotype correlation in the simplex variant.

The article below demonstrates the use of nanofibers to stabilise anchorage-dependant animal cells. The current emphasis is on finding a gene therapy treatment approach for this condition. May be a biophysical approach as below can also be tried!

"Biotechnol Lett. 2011 Dec 30. 


Efficient formation of cell spheroids using polymer nanofibers.


Shin JY, Park J, Jang HK, Lee TJ, La WG, Bhang SH, Kwon IK, Kwon OH, Kim BS.

Spheroid culture has been used for suspension cultures of anchorage-dependent
cells. In this study, we developed a new method for the suspension cultures of
anchorage-dependent animal cells using polymer nanofibers.
Poly(lactic-co-glycolic acid) nanofibers (785 nm in average fiber-diameter, 88 μm
in average fiber-length) fabricated by the electrospinning method were added to
each suspension culture of human embryonic kidney 293 cells and human dermal
fibroblasts."

'via Blog this'

Related articles

• Silkworms may help repair damaged hearts (gizmag.com)
• Natural Gene Therapy in Dystrophic Epidermolysis Bullosa [Observation] (archderm.ama-assn.org)

Amyloidogenecity of Epidermal proteins: Unfolding the mysteries.

Image via Wikipedia

[This is the discussion section of my paper on cutaneous amyloidosis that I did not publish. I presented it in a conference though. The methodology is posted in my bioinformatics blog. Poster can be downloaded here: http://www.box.com/s/uae8yijuohefphzoh4cx under

Amyloidogenecity of Epidermal proteins by Bell Raj Eapen is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.

Our findings show that collagen, especially the alpha subunit of type VI collagen has many more amyloidogenic regions than keratin. The V324A mutation on KRT 5 did not change the amyloidogenecity of keratin. The role of collagen and fibroblasts in cutaneous amyloidosis has long been suspected. Amyloid reacts with anti-collagen antibodies along with anti-keratin antibodies, though both of these can be passive immuno-adsorption. These findings add credence to this theory, though further studies are required to conclusively prove the role of collagen in the pathogenesis of cutaneous amyloidogenesis.

CA is known to be associated with friction and tractional force on the skin. A rare diffuse form called Amyloidosis Cutis Dyschromica is supposed to be related to sun exposure. Type VI collagen is a ubiquitous microfibrillar collagen involved in cell adhesion. Hence it may get disrupted with sustained friction leading to amyloid formation. The 3 subunit of type VI collagen increases in the dermo-epidermal junction of photo damaged skin. This may explain the rare association with sun exposure.

Cutaneous amyloidosis is associated with a rippled pattern of pigmentation. This cannot be explained by the optical properties of amyloid. The intraluminal fibrous striations in melanosomes, upon which melanin granules form, are structurally similar to amyloid. Hence amyloid deposits can act as a facade on which melanin granules can get deposited thereby preventing its elimination. That is probably why treatment strategies involving blockage of tyrosinase rarely improve pigmentation in cutaneous amyloidosis.

The two treatment modalities available for cutaneous amyloidosis are DMSO and Colchicine. However the mechanism of action of both drugs in CA is not known. DMSO is known to cause dissolution of collagen. Colchicine is an inhibitor of collagen synthesis useful in scleroderma as well. Hence the beneficial effect of both these drugs on amyloidosis may be related to their effect on collagen.

Related articles

• Noncore Residues Influence the Kinetics of Functional TTR(105-)(115)-Based Amyloid Fibril Assembly. (ncbi.nlm.nih.gov)